经髂腹股沟入路髋臼周围截骨治疗中年髋关节发育不良

Periacetabular osteotomy through ilioinguinal approach for the treatment of developmental dysplasia of the hip in middle-aged adults

目的探讨经髂腹股沟入路髋臼周围截骨治疗中年髋关节发育不良的手术适应证及疗效。方法回顾性分析2005年8月至2010年2月采用经髂腹股沟入路髋臼周围截骨术治疗10例髋关节发育不良患者资料，男3例，女7例；年龄40-47岁，平均42岁；3例为双侧（单侧手术）、7例为单侧髋关节发育不良；左侧4例，右侧6例。2例有既往手术史，其中1例行Chaff截骨术，1例行髋臼造盖术。髋关节骨关节炎分期：Tonnis0期3例，I期5例，Ⅱ期2例。6例Shenton线不连续。髋臼外侧CE角3．50°±4．88°，前侧CE角1．80°±5．07°，髋臼顶倾斜角18．20°±3．01°，股骨头超出指数31.30％±4．37％，Harris髋关节评分（67．40±7．75）分。结果10例患者均获得随访，随访时间10~76个月，平均37个月。1例术前TonnisI期者术后改善为0期，1例Ⅱ期者改善为I期，其余分期无变化。术后2例Shenton线不连续。末次随访外侧CE角30．40°±3.31°，前侧CE角29．50°±3．03°，髋臼顶倾斜角4．50°±2．55°，股骨头超出指数9．90％±4．33％，Harris髋关节评分（84．10±4．07）分。3例出现股外侧皮神经支配区感觉麻木，4-6个月自行恢复。1例出现髂窝血肿，2周后吸收消失，无残留症状。结论只要严格掌握手术适应证，术中精细操作，经髂腹股沟入路髋臼周围截骨可治疗中年髋关节发育不良。

Objective To investigate the indications and mid-term outcomes of periacetabular os- teotomy through ilioinguinal approach for developmental dysplasia of the hip （DDH） in middle-aged （40-50 years old） adult patients. Methods Data of 10 adult patients who had undergone periacetabular osteotomies through ilioinguinal approach for DDH from August 2005 to February 2010 were retrospectively analyzed. There were 7 females and 3 males, aged from 40 to 47 years （average, 42 years）. Bilateral hips were involved in 3 patients, and unilateral hip was involved in 7 patients. Before this hospitalization, 1 patient had received Chari osteotomy, and 1 had received hip-shelf procedure. According to the Tonnis classification, 3 hips were classified as Grade 0, 5 as Grade I and 2 as Grade II. The Shenton line was discontinuous in 6 hips. The av- erage lateral center-edge angle was 3.50°±4.88°; the average anterior center-edge angle was 1.80°±5.07°; the average acetabular index angle was 18.20°±3.01°; the average femoral head extrusion index was 31.30%±4.37%; the average Harris hip score was 67.40±7.75. Changes of the indexes mentioned above were observed during the whole period of follow-up. Results All patients were followed up for 10 to 76 months （average, 37 months）. The Tonnis grade improved in 2 cases, from preoperative Grade I and Grade II to Grade 0 and Grade I at final follow-up, respectively. At final follow-up, the Shenton line was discontinuous in 2 hips; the average lateral center-edge angle improved to 30.40°±3.31°, the average anterior center-edge angle improved to 29.50°±3.03°, the average acetabular index angle decreased to 4.50°±2.55°, the average femoral head ex- trusion index decreased to 9.90%±4.33%; the average Harris hip score increased to 84.10±4.07. The major complications included 3 cases of lateral femoral cutaneous nerve palsy which recovered in 4 to 6 months, and 1 case of iliac fossa hematoma which disappeared in 2 weeks. Conclusion With more strict surgery in- dication and more meticulous manipulation, periacetabular osteotomy through ilioinguinal approach can achieve satisfactory results in the treatment of DDH in middle-aged adults, which can increase hip joint con- gruence, relieve hip symptom and delay progression of osteoarthritis.